Clinical Reasoning Case #4

Question 1

My DDx is developed mostly from my exam that I gather from the patient and then supplemented by the history
(T/F)

Answer 1

False

Question 2

Your history will aid in about ____% of your DDX and then your physical exam will supplement that information to develop a working diagnosis

Answer 2

80%

Question 3

___% of the US population currently has, or has already had 1 or more episodes of back pain in the past 3 months

Answer 3

39%; Chronic LBP is common

Question 4

LMNOPQRST PAA PAA is used for:

Answer 4

History of Present Illness

Question 5

NMSVv is used for:

Answer 5

Differential Diagnosis

Question 6

HIPPIRONILS is used for:

Answer 6

Clinical Flow

Question 7

Scheurmann Disease

Answer 7

-A type of osteochondrosis
-Juvenile Kyphosis AKA
-Irritation of a growth center causing inflammation, which causes proliferation, poorly developed cartilage, fragmentation/irregularity
-Typically a genetic component
-Occurs w/ ADOLESCENTS (To be acute)! Have to be skeletally immature
-Not active in older adults

Question 8

Where does Scheurmann’s Disease occur

Answer 8

-Thoracic spine mostly, but can be lumbar
-Presents as a rigid painful thoracic kyphosis

Question 9

Contributing factors of Scheurmanns Disease

Answer 9

Mechanical stress
-Seen in athletes
-Young manual labourers

Question 10

Osgood-Schlatter Disease

Answer 10

-Male Dominance
-11-15 years old
-History of single traumatic injury or repetitve stress
-Partial disruption at tibial tuberosity
-Pain, swelling, tenderness

Question 11

Scheurmann Disease findings

Answer 11

Anterior vertebral body wedging
-Irregular endplates
-Decreased IVD heights
-Postural abnormalities
-Acute in skeletal..

Question 12

Additional findings of Scheurmanns

Answer 12

-Thoracic spine kyphosis >40*
Atleast 3 adjacent vertebrae demonstrating >5*
-Schmorls nodes
-Irregular endplates

Question 13

Five Things Physicians and Patients Should Question

Answer 13

1. Do not obtain spinal imaging for patients w/ acute LBP during the 6 weeks after onset in the absence of red flags
2. Do not perform repeat imaging to monitor patient’s progress
3. Avoid protracted use of passive or palliative physical therapeutic modalities for LBP disorders unless they support the goals of an active treatment plan
4. Do not provide long-term pain management w/o a psychosocial screening or assessment
5. Do not prescribe lumbar supports or braces for the long-term treatment or prevention of LBP

Question 14

Biological Components in the BPS model

Answer 14

-Age, gender, genetics
-Physiologic Reactions
-Tissue Health

Question 15

Psychological Components of the BPS model

Answer 15

-Mental Health
-Emotional Health
-Beliefs and Expectations

Question 16

Sociological Components of the BPS Model

Answer 16

-Interpersonal Relationships
-Social Support Dynamics
-Socioeconomics

Question 17

What does the “Triad of Health” Include

Answer 17

Nutritional/Chemical, Structural/Physical, Emotional/Mental

Question 18

Point prevalence of chronic pain among adults has been measured at up to ___% of the population in both developed and developing countries

Answer 18

41%

Question 19

In the United States chronic pain is estimated to affect more than _______ adults, producing over _______dollars of direct and indirect costs each year

Answer 19

100 million; $600 billion

Question 20

What accounts for the greatest cause of disability in both men and women in most countries worldwide?

Answer 20

Low back and neck pain

Question 21

What is the dominant model to explain and manage pain

Answer 21

BPS model

Question 22

Psychosocial factors shown to negatively contribute to heightened pain, awareness and disability

Answer 22

Fear-avoidance beliefs, depression and anxiety, PTSDs, unsupportive social and interpersonal relationships, low levels of self efficacy and maladaptive beliefs

Question 23

The ________ Model is an example of the interconnectedness between biological and psychosocial influences that may contribute to persistent pain

Answer 23

Fear-Avoidance

Question 24

In the Field study, Most patients that presented to an initial chiropractic visit with _____scores of psychological distress showed a _____ in these scores after a few days post visit

Answer 24

Higher; decrease

Question 25

Psychosocial interventions used to develop resilience toward chronic pain

Answer 25

-CBT: Positive thinking, pain distracting activities, active relaxation exercises and stretching
-ACT: Mindfulness meditation, educational interventions such as “Explaining Pain” sessions

Question 26

American College of Physicians non-pharmalogic guidelines

Answer 26

Mindful-based stressed reduction, progressive relaxation, CBT, exercise, yoga, tai chi, spinal manipulation and rehabilitation

Question 27

Evans ABCS pneumonic

Answer 27

-A: Assess overall health
-B: Benefits of positive behaviour change for patient
-C: Routine chiropractic visits
-S: Stay the Course

Question 28

When asked if they had tried to make changes in behavior at the advice of their chiropractor or osteopath, they reported an attempt to make changes in their health care behavior greater than ___of the time

Answer 28

85%

Question 29

The ________ Model suggests that not only must self-efficacy be enhanced for successful behavior change, but the perceived benefits of changing a behavior must outweigh any negatives or barriers

Answer 29

Health Belief Model

Question 30

Motivational Interviewing (MI)

Answer 30

-Helps identifying behavioural change, motivation and obstacles in patient-centered discussion
-Specifically designed for primary care setting where time is limited

Question 31

Principles of MI

Answer 31

1. Expressing empathy for the patient/health issue
2. Developing discrepancy between what needs to occur and what the patient is expressing/willing to do
3. “Rolling w/ resistance”-when patient expresses negativity to making changes
4. Supporting self-efficacy: Doctor is ready to help when the patient is willing to make changes

Question 32

CBT (Cognitive Behavioural Therapy)

Answer 32

-Structured approach that concentrates on the relationships between thoughts, emotions and behaviours
-Nurtures patient development and uses active problem solving skills in order to manage challenges with chronic pain

Question 33

ACT

Answer 33

-Aims to focus on processes of language that are though to be involved in psychopathology and it’s amelioration
-Includes the viewpoint that attempting to change problematic thoughts and feelings as a means of coping can be disparaging